Viral hemorrhagic fevers

Viral hemorrhagic fevers

Definition:

Viral hemorrhagic (hem-uh-RAJ-ik) fevers are infectious diseases that interfere with the blood's natural ability to clot. These diseases can also damage the walls of tiny blood vessels, making them leaky. The internal bleeding that results can range from relatively minor to life-threatening.
Some viral hemorrhagic fevers include:

• Dengue
• Ebola
• Lassa
• Marburg
• Yellow fever

These diseases most commonly occur in tropical areas of the world. When viral hemorrhagic fevers occur in the United States, they're usually found in people who've recently traveled internationally.
Viral hemorrhagic fevers are spread by contact with infected animals, people or insects. No current treatment can cure viral hemorrhagic fevers, and immunizations exist for only a few types. Until additional vaccines are developed, the best approach is prevention.

Symptoms:

Signs and symptoms of viral hemorrhagic fevers vary by disease. In general, initial symptoms may include:

• High fever
• Fatigue
• Dizziness
• Muscle aches
• Weakness

Symptoms can become life-threatening
Severe cases of some types of viral hemorrhagic fevers may cause bleeding:

• Under the skin
• In internal organs
• From the mouth, eyes or ears

Other signs and symptoms of severe infections can include:

• Shock
• Nervous system malfunctions
• Coma
• Delirium
• Seizures
• Kidney failure

When to see a doctor
The best time to see a doctor is before you travel to a developing country to ensure you've received any available vaccinations and pre-travel advice for staying healthy. If you develop signs and symptoms once you return home, consider consulting a doctor who focuses on international medicine or infectious diseases. A specialist may be able to recognize and treat your illness faster. Be sure to let your doctor know what areas you've visited.

Causes:

The viruses that cause viral hemorrhagic fevers live naturally in a variety of animal and insect hosts — most commonly mosquitoes, ticks, rodents or bats.
Each of these hosts typically lives in a specific geographic area, so each particular disease usually occurs only where that virus's host normally lives. Some viral hemorrhagic fevers also can be transmitted from person to person.

How is it transmitted?
The route of transmission varies by specific virus. Some viral hemorrhagic fevers are spread by mosquito or tick bites. Others are transmitted by contact with infected blood or semen. A few varieties are breathed in if you're around infected rat feces or urine.

If you travel to an area where a particular hemorrhagic fever is common, you may become infected there and then develop symptoms after you return home

Complications:

Viral hemorrhagic fevers can damage your:

• Brain
• Eyes
• Heart
• Kidneys
• Liver
• Lungs
• Spleen

In some cases, the damage is severe enough to cause death.

Treatments and drugs:

Medications
While no specific treatment exists for most viral hemorrhagic fevers, the antiviral drug ribavirin (Virazole, Rebetol) may help shorten the course of infection and prevent complications in some cases.

Therapy
Supportive care is essential. To prevent dehydration, you may need fluids to help maintain your balance of electrolytes — minerals that are critical to nerve and muscle function.

Surgical and other procedures
Some people may benefit from kidney dialysis, an artificial way of cleaning wastes from your blood when your kidneys fail.

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Viral gastroenteritis (stomach flu)

Viral gastroenteritis (stomach flu)

Definition:

Viral gastroenteritis is an intestinal infection marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever.

The most common way to develop viral gastroenteritis — often called stomach flu — is through contact with an infected person or ingestion of contaminated food or water. If you're otherwise healthy, you'll likely recover without complications. But for infants, older adults and people with compromised immune systems, viral gastroenteritis can be deadly.

There's no effective treatment for viral gastroenteritis, so prevention is key. In addition to avoiding food and water that may be contaminated, thorough and frequent hand-washing is your best defense.

Symptoms  :

Although it's commonly called stomach flu, gastroenteritis isn't the same as influenza. Real flu (influenza) affects your respiratory system — your nose, throat and lungs. Gastroenteritis, on the other hand, attacks your intestines, causing signs and symptoms such as:

• Watery, usually nonbloody diarrhea — bloody diarrhea usually means you have a different, more severe infection
• Abdominal cramps and pain
• Nausea, vomiting or both
• Occasional muscle aches or headache
• Low-grade fever

Depending on the cause, viral gastroenteritis symptoms may appear within one to three days after you're infected and can range from mild to severe. Symptoms usually last just a day or two, but occasionally they may persist as long as 10 days.

Because the symptoms are similar, it's easy to confuse viral diarrhea with diarrhea caused by bacteria such as salmonella and E. coli or parasites such as giardia.

When to see a doctor
If you're an adult, call your doctor if:

• You're not able to keep liquids down for 24 hours
• You've been vomiting for more than two days
• You're vomiting blood
• You're dehydrated — signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness
• You notice blood in your bowel movements
• You have a fever above 104 F (40 C)

For infants and children
See your doctor right away if your child:

• Has a fever of 102 F (38.9 C) or higher
• Seems lethargic or very irritable
• Is in a lot of discomfort or pain
• Has bloody diarrhea
• Seems dehydrated — watch for signs of dehydration in sick infants and children by comparing how much they drink and urinate with how much is normal for them

If you have an infant, remember that while spitting up may be an everyday occurrence for your baby, vomiting is not. Babies vomit for a variety of reasons, many of which may require medical attention.
Call your baby's doctor right away if your baby:

• Has vomiting that lasts more than several hours
• Hasn't had a wet diaper in six hours
• Has bloody stools or severe diarrhea
• Has a sunken fontanel — the soft spot on the top of your baby's head
• Has a dry mouth or cries without tears
• Is unusually sleepy, drowsy or unresponsive

Causes:

You're most likely to contract viral gastroenteritis when you eat or drink contaminated food or water, or if you share utensils, towels or food with someone who's infected.
Viruses that can cause gastroenteritis include:

• Rotavirus. Children are usually infected when they put their fingers or other objects contaminated with the virus into their mouths. Adults infected with rotavirus may not have symptoms, but can still spread the illness — of particular concern in institutional settings because infected adults unknowingly can pass the virus along to others. Some people, particularly those in institutional settings, may spread the virus even though they don't have any symptoms of illness themselves. A vaccine against rotaviral gastroenteritis is available in some countries, including the United States, and appears to be effective in preventing severe symptoms.
  
• Noroviruses. Both children and adults are affected by noroviruses. Norovirus infection can sweep through families and communities. It's especially likely to spread among people in confined spaces. In most cases you pick up the virus from contaminated food or water, although person-to-person transmission also is possible.

Some shellfish, especially raw or undercooked oysters, also can make you sick. Contaminated drinking water is another cause of viral diarrhea. But in many cases, the virus is passed through the fecal-oral route — that is, someone with the virus handles food you eat without washing his or her hands after using the toilet.

Complications:

The main complication of viral gastroenteritis is dehydration — a severe loss of water and essential salts and minerals. If you're healthy and drink enough to replace fluids you lose from vomiting and diarrhea, dehydration shouldn't be a problem.
Infants, older adults and people with suppressed immune systems may become severely dehydrated when they lose more fluids than they can replace. If that's the case, hospitalization might be needed so that lost fluids can be replaced intravenously. Rarely, dehydration can be fatal.

Treatments and drugs:
 
 There's often no specific medical treatment for viral gastroenteritis. Antibiotics aren't effective against viruses, and overusing them can contribute to the development of antibiotic-resistant strains of bacteria. Treatment consists of self-care measures.

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Trench mouth

Trench mouth

Definition  :

Trench mouth is a severe form of gingivitis that causes painful, infected, bleeding gums and ulcerations. Although trench mouth is rare today in developed nations, it's common in developing countries that have poor nutrition and poor living conditions.

Trench mouth is formally known as Vincent's stomatitis, acute necrotizing ulcerative gingivitis (ANUG) and necrotizing ulcerative gingivitis (NUG). Trench mouth earned its nickname because of its prevalence among soldiers who were stuck in the trenches during World War I without the means to take care of their teeth properly.

Symptoms:

Signs and symptoms of trench mouth can include:

• Severe gum pain
• Bleeding from gums when they're pressed even slightly
• Red or swollen gums
• Pain when eating or swallowing
• A gray film on your gums
• Crater-like sores (ulcers) between your teeth and on your gums
• A foul taste in your mouth
• Bad breath
• Fever
• Swollen lymph nodes around your head, neck or jaw

When to see a dentist
Trench mouth symptoms can develop quickly. See your dentist immediately if you develop any symptoms. Often these may be symptoms of a gum problem other than trench mouth, such as gingivitis or periodontitis. But all forms of gum disease can be serious, and most tend to get worse without treatment. The sooner you seek care, the better your chance of returning your gums to a healthy state and preventing loss of teeth and destruction of bone or other tissue.

Causes:

Your mouth naturally contains microorganisms, including fungi, viruses and bacteria. In trench mouth, though, harmful bacteria grow out of control, causing infection of your gums. This infection can damage or destroy the delicate gum tissue (gingiva) that surrounds and supports your teeth. Large ulcers, often filled with bacteria, food debris and decaying tissue, may form on your gums, leading to severe pain, bad breath and a foul taste in your mouth.

Precisely how these bacteria destroy gum tissue isn't known. But it's thought that enzymes and toxins produced by the bacteria play a role.

Complications:
 
Complications and problems that trench mouth may cause or be associated with include:

• Trouble swallowing
• Trouble eating
• Pain when brushing teeth
• Destruction of gum tissue
• Tooth loss
• Progression into advanced oral diseases that can severely damage bone and gum tissue

Treatments and drugs:

Treatment of trench mouth is generally highly effective, and complete healing often occurs in just a couple of weeks. However, healing may take longer if your immune system is compromised, such as by HIV/AIDS.

Medications
Because trench mouth involves an overgrowth of bacteria, antibiotics are often prescribed to eradicate the bacteria and prevent infection from spreading. You may also need over-the-counter or prescription pain relievers. Getting pain under control is important so that you can eat properly and resume good dental care habits, such as brushing your teeth. Your dentist may also recommend a pain reliever that you can apply directly to your gums (topical anesthetic).

Cleaning your teeth and gums
Treatment also includes a thorough but gentle cleaning of your teeth and gums. Your dentist removes any dead gum tissue (debridement) to help reduce pain. Your mouth may be rinsed with an antiseptic solution. When your gums are less tender, you'll undergo a type of tooth cleaning called scaling and root planing. This procedure removes plaque and tartar from beneath your gumline and smooths any roughened surfaces of your teeth.
Right after cleaning, your gums will be quite tender. Your dentist will probably advise you to rinse your mouth with a hydrogen peroxide mouthwash, salt water or a prescription mouth rinse, in addition to brushing gently with a soft toothbrush. Once your gums begin to heal, brush and floss at least twice a day — preferably after every meal and at bedtime — to prevent future problems.

When surgery is necessary
Although your gums are likely to heal and return to their normal shape with professional cleaning and proper home care, you may need surgery to help repair them if you have extensive damage.

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Vesicoureteral reflux

Vesicoureteral reflux

Definition:

Vesicoureteral (ves-ih-koe-yoo-REE-ter-ul) reflux is the abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladder. Normally, urine flows only down from your kidneys to your bladder.

Vesicoureteral reflux is usually diagnosed in infants and children. The disorder increases the risk of urinary tract infections, which, if left untreated, can lead to kidney damage.

Vesicoureteral reflux can be primary or secondary. Children with primary vesicoureteral reflux are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. Secondary vesicoureteral reflux is due to a urinary tract malfunction, often caused by infection.

Children may outgrow primary vesicoureteral reflux. Treatment, which includes medication or surgery, aims at preventing kidney damage.

Symptoms:

A urinary tract infection (UTI) is the most common indication of vesicoureteral reflux. A UTI doesn't always cause noticeable signs and symptoms, though most people have some. These signs and symptoms can include:

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Blood in the urine (hematuria) or cloudy, strong-smelling urine
• Fever
• Abdominal or flank pain
• Hesitancy to urinate or holding urine to avoid the burning sensation

A UTI may be difficult to diagnose in children, who may have only nonspecific signs and symptoms. Signs and symptoms in infants with a UTI may also include:

• Diarrhea
• Lack of appetite
• An unexplained fever
• Irritability

As your child gets older, untreated vesicoureteral reflux can lead to other signs and symptoms, including:

• Bed-wetting
• High blood pressure
• Protein in urine
• Kidney failure

Another indication of vesicoureteral reflux, which may be detected before birth by sonogram, is swelling of the kidneys or the urine-collecting structures of one or both kidneys (hydronephrosis) in the fetus, caused by the backup of urine into the kidneys.
When to see a doctor
Contact your doctor right away if your child develops any of the signs or symptoms of a UTI, such as:

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Abdominal or flank pain
• A hesitancy to urinate

Call your doctor about fever if your child:

• Is less than 3 months old and has a rectal temperature of 100.4 F (38 C) or higher
• Is 3 months or older and has a fever of 104 F (40 C)

In addition, call your doctor immediately if your infant has the following signs or symptoms:

• Changes in appetite. If your baby refuses several feedings in a row or eats poorly, contact the doctor.
• Changes in mood. If your baby is lethargic or unusually difficult to rouse, tell the doctor right away. Also let the doctor know if your baby is persistently irritable or has periods of inconsolable crying.
• Diarrhea. Contact the doctor if your baby's stools are especially loose or watery.
• Vomiting. Occasional spitting up is normal. Contact the doctor if your baby spits up large portions of multiple feedings or vomits forcefully after feedings.

Causes:

Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste products from your body.
The kidneys, a pair of bean-shaped organs at the back of your upper abdomen, filter waste, water and electrolytes — minerals, such as sodium, calcium and potassium, that help maintain the balance of fluids in your body — from your blood. Tubes called ureters carry urine from your kidneys down to your bladder, where it is stored until it exits the body through another tube (the urethra) during urination.

Vesicoureteral reflux can develop in two forms, primary and secondary:

• Primary vesicoureteral reflux. The cause of this more common form is a defect that's present before birth (congenital). The defect is in the functional valve between the bladder and a ureter that normally closes to prevent urine from flowing backward. As the child grows, the ureters lengthen and straighten, which may improve valve function and eventually resolve the reflux. This type of vesicoureteral reflux tends to run in families, which indicates that it may be genetic, but the exact cause of the defect is unknown.
• Secondary vesicoureteral reflux. The cause of this form is a blockage or malfunction in the urinary system. The blockage most commonly results from recurrent UTIs, which may cause swelling of a ureter

Complications:

Kidney damage is the primary concern with vesicoureteral reflux. The more severe the reflux, the more serious the complications are likely to be. Complications may include:

• Kidney (renal) scarring. Untreated UTIs can lead to scarring, also known as reflux nephropathy, which is permanent damage to kidney tissue. A backup of urine exposes the kidneys to higher than normal pressure, which can lead to scarring over time. Extensive scarring may lead to high blood pressure and kidney failure.
• High blood pressure (hypertension). Because the kidneys remove waste from the bloodstream, damage to your kidneys and the resultant buildup of wastes can raise your blood pressure.
• Kidney failure. Scarring can cause a loss of function in the filtering part of the kidney. This may lead to kidney failure, which can occur quickly (acute) or it may develop over time (chronic). In either case, dialysis or a kidney transplant may be necessary. Dialysis is an artificial means of removing extra fluids and waste from your blood.

Treatments and drugs:

Treatment options for vesicoureteral reflux depend on the severity of the condition. Children with mild cases of primary vesicoureteral reflux may eventually outgrow the disorder. In this case, your doctor will likely recommend a wait-and-see approach. During this time, it will be important for you to be watchful for potential UTIs and to seek prompt treatment.

Children with moderate to severe primary vesicoureteral reflux have two treatment options: medication and surgery. Using medication is more common, with surgery usually reserved for those children for whom antibiotics aren't successful.
However, surgery may be a first line therapy for grades IV and V or for families who prefer a quicker, more definitive treatment than medication.

Medications
UTIs require prompt treatment with antibiotics to keep the infection from moving to the kidneys. Doctors may also use antibiotics to prevent UTIs, usually at about half the dose for treating an infection.

Commonly used antibiotics for prevention include the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra), trimethoprim (Primsol) and nitrofurantoin (Furadantin, Macrobid, Macrodantin). Some people may be allergic to one or more of these medications, preventing their use. Possible side effects of long-term use of these drugs include:

• Nausea and vomiting
• Abdominal pain
• Increased antibiotic resistance, in which the infection no longer responds to antibiotics and becomes more difficult to treat

A child being treated with medication needs to be monitored for as long as he or she is taking antibiotics. This includes periodic physical exams and urine tests to detect breakthrough infections — UTIs that occur despite the antibiotic treatment — and occasional radiographic scans of the bladder and kidneys to determine if your child has outgrown vesicoureteral reflux.

Surgery
Surgery for vesicoureteral reflux repairs the defect in the functional valve between the bladder and each affected ureter that keeps it from closing and preventing urine from flowing backward. There are two methods of surgical repair:

• Open surgery. Performed using general anesthesia, this surgery requires an incision in the lower abdomen through which the surgeon repairs the malformation that's causing the problem. This type of surgery usually requires a few days' stay in the hospital, during which a catheter is kept in place to drain your child's bladder. Risks include infection, blood clots and bleeding.
• Endoscopic surgery. In this procedure, the doctor inserts a lighted tube (cystoscope) through the urethra to see inside your child's bladder, then injects a bulking agent around the opening of the affected ureter to try to strengthen the valve's ability to close properly. This method is minimally invasive compared with open surgery and presents fewer risks, though it may not be as effective. This procedure also requires general anesthesia, but generally can be performed as outpatient surgery.

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Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV)

Definition:

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.
Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.

Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.

Symptoms:

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

• Dizziness
• A sense that you or your surroundings are spinning or moving (vertigo)
• Lightheadedness
• Unsteadiness
• A loss of balance
• Blurred vision associated with the sensation of vertigo
• Nausea
• Vomiting

The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of benign paroxysmal positional vertigo and other forms of vertigo can disappear for some time and then recur.
Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo. Although rare, it's possible to have BPPV in both ears (bilateral BPPV).

When to see a doctor
Generally, see your doctor if you experience any unexplained dizziness or vertigo that recurs periodically for more than one week.

Seek emergency care
Although it's uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:

• A new, different or severe headache
• A fever of 101 F (38 C) or higher
• Double vision or loss of vision
• Hearing loss
• Trouble speaking
• Leg or arm weakness
• Loss of consciousness
• Falling or difficulty walking
• Numbness or tingling
• Chest pain, or rapid or slow heart rate

The signs and symptoms listed above may signal a more serious problem, such as stroke or a cardiac condition

Causes:

About half the time, doctors can't find a specific cause for BPPV.
When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back. BPPV also has been associated with migraines.

The ear's role
Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.

Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head's position related to gravity. These otolith organs — the utricle and saccule — contain crystals that make you sensitive to gravity.

For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you're lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy.

Complications:

 Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. In rare cases, if severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration. The dizziness of BPPV can put you at greater risk of falling.

Treatments and drugs:

To help relieve benign paroxysmal positional vertigo (BPPV), your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure.

Canalith repositioning
Performed in your doctor's office, the canalith repositioning procedure consists of several simple and slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs (utricle) in your ear where these particles don't cause trouble and are more easily resorbed. Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure is usually effective after one or two treatments.

After the procedure, you must avoid lying flat or placing the treated ear below shoulder level for the rest of that day. For the first night following the procedure, elevate your head on a few pillows when you sleep. This allows time for the particles floating in your labyrinth to settle into your vestibule and be resorbed by the fluids in your inner ear.

On the morning after your in-office procedure, your restrictions will be lifted and you'll begin self-care as directed by your doctor. Your doctor likely will have taught you how to perform the canalith repositioning procedure on yourself so that you can do it at home before returning to the office for a recheck.

Surgical alternative
In very rare situations in which the canalith repositioning procedure isn't effective, your doctor may recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear that's causing dizziness. The plug prevents the semicircular canal in your ear from being able to respond to particle movements or head movements in general. This success rate for canal plugging surgery is greater than 90 percent.

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Ventricular septal defect (VSD)

Ventricular septal defect (VSD)

Definition:

A ventricular septal defect (VSD), also called a hole in the heart, is a common heart defect that's present at birth (congenital). The defect involves an opening (hole) in the heart forming between the heart's lower chambers, allowing oxygen-rich and oxygen-poor blood to mix.

A baby with a small ventricular septal defect may have no problems. A baby with a larger ventricular septal defect or associated heart defects may have a telltale bluish tint to the skin (cyanosis) — due to oxygen-poor blood — often most visible in the lips and fingernails. Ventricular septal defects are sometimes not diagnosed until adulthood.

Fortunately, ventricular septal defect is treatable. Many small ventricular septal defects often close on their own or don't cause problems. Larger ventricular septal defects need surgical repair early in life to prevent complications. Some smaller ventricular septal defects are closed to prevent complications related to their location, such as damage to heart valves. Many people with small ventricular septal defects have normal, productive lives with few related problems.

Symptoms:

Signs and symptoms of serious heart defects often appear during the first few days, weeks or months of a child's life.
Ventricular septal defect symptoms in a baby may include:

• A bluish tint to the skin, lips and fingernails (cyanosis)
• Poor eating, failure to thrive
• Fast breathing or breathlessness
• Easy tiring
• Swelling of legs, feet or abdomen
• Rapid heart rate

Although these signs can be caused by other conditions, they may be due to a congenital heart defect.
You and your doctor may not notice signs of a ventricular septal defect at birth. If the defect is small, symptoms may not appear until later in childhood — if ever. Signs and symptoms vary depending on the size of the hole. Your doctor may first suspect a heart defect during a regular checkup while listening to your baby's heart with a stethoscope.

Sometimes a ventricular septal defect isn't detected until a person reaches adulthood. Signs or symptoms can include shortness of breath and a loud heart murmur your doctor can hear when listening to your heart with a stethoscope.

When to see a doctor
Call your doctor if your baby or child:

• Tires easily when eating or playing
• Is not gaining weight
• Becomes breathless when eating or crying
• Has a bluish tint to his or her skin, especially around the fingernails and lips
• Breathes rapidly or is short of breath

Call your doctor if you develop:

• Shortness of breath when you exert yourself or when you lie down
• Rapid or irregular heartbeat
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet

Causes:

Heart defects that are present at birth (congenital) arise from problems early in the heart's development, but there's often no clear cause. Genetics and environmental factors probably play a role.
A ventricular septal defect occurs when the septum, the muscular wall separating the heart into left and right sides, fails to form fully between the lower chambers of the heart (ventricles) during fetal development. This leaves an opening that allows mixing of oxygenated blood and deoxygenated blood, meaning the heart has to work harder to provide enough oxygen to your body's tissues.

If a ventricular septal defect is large, blood overfills the lungs and overworks the heart. If left untreated, the blood pressure in the lungs goes up (pulmonary hypertension) and the ventricles enlarge and no longer work efficiently. Ultimately, this can lead to irreversible damage to the lung arteries and to heart failure. In contrast, small ventricular septal defects don't usually cause any problems, except for a loud heart murmur that doctors may note during physical exams.

Complications:

A small ventricular septal defect may never cause any problems. Larger defects can cause a range of disabilities — from mild to life-threatening. Treatment can prevent many complications.

Eisenmenger's syndrome
If a large ventricular septal defect goes untreated, increased blood flow to the lungs causes high blood pressure in the lung arteries (pulmonary hypertension). Over time, permanent damage to the lung arteries develops and the pulmonary hypertension can become irreversible.

This complication, called Eisenmenger's syndrome, usually develops in early childhood. In people with Eisenmenger's syndrome, a significant portion of blood flows through the ventricular septal defect from the right ventricle to the left and bypasses the lungs.

This means deoxygenated blood is pumped to the body and leads to a bluish discoloration of the lips, fingers and toes (cyanosis) and other complications. Once a person has Eisenmenger's syndrome, it's too late to surgically repair the hole because irreversible damage to the lung arteries has already occurred.

Other complications
Other complications may include:

• Heart failure. The increased blood flow through the heart due to a ventricular septal defect can also lead to heart failure, a chronic condition in which the heart can't pump effectively.
• Endocarditis. People with a ventricular septal defect are at increased risk of an infection of the heart (endocarditis).
• Stroke. People with large defects, especially occurring with Eisenmenger's syndrome, are at risk of a stroke due to a blood clot passing through the hole in the heart and going to the brain.
• Other heart problems. Ventricular septal defects can also lead to abnormal heart rhythms and valve problems.

Ventricular septal defect and pregnancy
Becoming pregnant is often a concern for women born with a heart defect. Having a repaired ventricular septal defect without any complications or having a very small defect doesn't pose any additional risk in pregnancy. However, having an unrepaired larger defect, heart failure, cyanosis or other heart defects poses a high risk to both mother and fetus. Women with Eisenmenger's syndrome are at the highest risk of complications.

Doctors strongly advise these women not to become pregnant.
Any woman with a congenital heart defect, repaired or not, who is considering pregnancy should talk beforehand with a doctor who specializes in the diagnosis and treatment of heart conditions (cardiologist). This is especially important if you're taking medications. It's also important to see both an obstetrician and a cardiologist during pregnancy.

Treatments and drugs:

Many babies born with a small ventricular septal defect won't ever need to have the defect surgically closed. After birth, your doctor may want to observe your baby and treat any symptoms while waiting to see if the defect will close on its own.

Children and adults who have a ventricular septal defect that is large or is causing significant symptoms usually need surgery to close the defect. If your baby has a ventricular septal defect that needs surgical repair, the procedure will likely be scheduled in your baby's first year of life.
Medications
Medications for ventricular septal defect may include those to:

• Keep the heartbeat regular. Examples include beta blockers (Lopressor, Inderal, others) and digoxin (Lanoxin, Lanoxicaps, Lanoxin Pediatric).
• Increase the strength of the heart's contractions. Examples include digoxin (Lanoxin).
• Decrease the amount of fluid in circulation. Doing so reduces the volume of blood that must be pumped. These medications, called diuretics, include furosemide (Lasix).

Procedures
Surgical treatment for ventricular septal defects involves plugging or patching the abnormal opening between the ventricles. Two approaches are used:

• Surgical repair. This is the procedure of choice in most cases. Surgical repair of a ventricular septal defect usually involves open-heart surgery, which is done under general anesthesia. The surgery requires a heart-lung machine and an incision in the chest. The doctor uses patches or stitches to close the hole.
  
• Catheter procedure. This method may be used to close some ventricular septal defects. Patching during catheterization doesn't require opening the chest. Rather than opening the chest, the doctor inserts a thin tube (catheter) into a blood vessel in the groin and guides it to the heart. The doctor then uses a small mesh patch or plug to close the hole.
  
• Hybrid procedure. A hybrid procedure uses surgical and catheter-based techniques. Access to the heart is usually through a small incision and the procedure may be performed without stopping the heart and using the heart-lung machine. A plug is delivered to close the VSD via a catheter placed through the small hole that the surgeon created. Recovery from this procedure is quicker than with standard surgery.

After repair, your doctor will schedule regular medical follow-up to ensure that the ventricular septal defect remains closed. Depending on the size of the ventricular septal defect and the presence or absence of any other problems, your doctor will tell you how frequently you or your child will need to be seen.
Surgery to close a ventricular septal defect generally has excellent long-term results.

Preventive antibiotics
If you've been told in the past that you or your child needs to take antibiotics before dental or medical procedures to reduce the risk of infective endocarditis, talk with your doctor. Endocarditis is much more likely to occur from exposure to random germs than from a typical dental exam or surgery. Current guidelines recommend preventive antibiotic treatment only for those people at highest risk of serious complications from infective endocarditis.
Your doctor may still recommend preventive antibiotics if you:

• Have other heart conditions or artificial valves
• Have a large ventricular septal defect that's causing a low blood oxygen level
• Have had a repair with artificial (prosthetic) material

For most people with a ventricular septal defect, practicing good oral hygiene and getting regular dental checkups is the most effective strategy for preventing endocarditis.

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Endometrial cancer

Endometrial cancer

Definition:

Endometrial cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ in women where fetal development occurs.

Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is sometimes called uterine cancer. Other types of cancer can form in the uterus, but they are much less common than endometrial cancer.

Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often eliminates all of the cancer.

Symptoms:

Signs and symptoms of endometrial cancer may include:

• Vaginal bleeding after menopause
• Prolonged periods or bleeding between periods
• An abnormal, watery or blood-tinged discharge from your vagina
• Pelvic pain
• Pain during intercourse

When to see a doctor
Make an appointment with your doctor if you experience any signs or symptoms that worry you, such as vaginal bleeding or discharge not related to your periods, pelvic pain, or pain during intercourse.

Causes:

 Doctors don't know what causes endometrial cancer. What's known is that something occurs to create a genetic mutation within cells in the endometrium — the lining of the uterus. The genetic mutation turns normal, healthy cells into abnormal cells.

Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of control, and they don't die at a set time. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).

Complications:

 Endometrial cancer can spread to other parts of your body, making it more difficult to treat successfully. Endometrial cancer that spreads (metastasizes) most often travels to the lungs.

Treatments and drugs:

Your options for treating your endometrial cancer will depend on the characteristics of your cancer, such as the stage, your general health and your preferences.

Surgery
Surgery to remove the uterus is recommended for most women with endometrial cancer. Most women with endometrial cancer undergo a procedure to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy). A hysterectomy makes it impossible for you to have children in the future. Also, once your ovaries are removed, you'll experience menopause, if you haven't already.
During surgery, your surgeon will also inspect the areas around your uterus to look for signs that cancer has spread. Your surgeon may also remove lymph nodes for testing. This helps determine your cancer's stage.

Radiation
Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. In some instances, your doctor may recommend radiation to reduce your risk of a cancer recurrence after surgery. If you aren't healthy enough to undergo surgery, you may opt for radiation therapy only. In women with advanced endometrial cancer, radiation therapy may help control cancer-related pain.
Radiation therapy can involve:

• Radiation from a machine outside your body. Called external beam radiation, during this procedure you lie on a table while a machine directs radiation to specific points on your body.
  
• Radiation placed inside your body. Internal radiation, or brachytherapy, involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time.

Hormone therapy
Hormone therapy involves taking medications that affect hormone levels in the body. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus. Options include:

• Medications to increase the amount of progesterone in your body. Synthetic progestin, a form of the hormone progesterone, may help stop endometrial cancer cells from growing.
  
• Medications to reduce the amount of estrogen in your body. Hormone therapy drugs can help lower the levels of estrogen in your body or make it difficult for your body to use the available estrogen. Endometrial cancer cells that rely on estrogen to help them grow may die in response to these medications.

Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or two or more drugs can be used in combination. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). Chemotherapy may be an option for women with advanced endometrial cancer that has spread beyond the uterus. These drugs enter your bloodstream and then travel through your body, killing cancer cells.

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